CHD and respiratory syncytial virus: global expert exchange recommendations.

BACKGROUND: Palivizumab is the standard immunoprophylaxis against serious disease due to respiratory syncytial virus infection. Current evidence-based prophylaxis guidelines may not address certain children with CHD within specific high-risk groups or clinical/management settings. METHODS: An international steering committee of clinicians with expertise in paediatric heart disease identified key questions concerning palivizumab administration; in collaboration with an additional international expert faculty, evidence-based recommendations were formulated using a quasi-Delphi consensus methodology. RESULTS: Palivizumab prophylaxis was recommended for children with the following conditions: <2 years with unoperated haemodynamically significant CHD, who are cyanotic, who have pulmonary hypertension, or symptomatic airway abnormalities; <1 year with cardiomyopathies requiring treatment; in the 1st year of life with surgically operated CHD with haemodynamically significant residual problems or aged 1-2 years up to 6 months postoperatively; and on heart transplant waiting lists or in their 1st year after heart transplant. Unanimous consensus was not reached for use of immunoprophylaxis in children with asymptomatic CHD and other co-morbid factors such as arrhythmias, Down syndrome, or immunodeficiency, or during a nosocomial outbreak. Challenges to effective immunoprophylaxis included the following: multidisciplinary variations in identifying candidates with CHD and prophylaxis compliance; limited awareness of severe disease risks/burden; and limited knowledge of respiratory syncytial virus seasonal patterns in subtropical/tropical regions. CONCLUSION: Evidence-based immunoprophylaxis recommendations were formulated for subgroups of children with CHD, but more data are needed to guide use in tropical/subtropical countries and in children with certain co-morbidities.

Two generations of identical twins with ELN deletion.

We report a family with three generations of an ELN deletion. The grandfather was normal except for two inguinal herniotomies. The first generation identical twins had supravalvular aortic and multiple peripheral pulmonary artery stenoses. The second generation twins died during the neonatal period of myocardial infarcts.

The burden of pneumonia in children in the developed world.

There are few comprehensive epidemiological studies of pneumonia in the developed world. Ascertainment and definition are important variables in the estimation of pneumonia incidence both in primary care and from hospital data. The available figures suggest a burden of disease in the order of 10-15 cases/1000 children per year and a hospital admission rate of 1-4/1000 per year. Both incidence and hospital admission are greatest in the youngest children and rapidly fall after the age of 5 years. In a majority of cases of community acquired pneumonia an organism is not identified. Viral infections are common and influenza A, B, respiratory syncitial virus (RSV) and parainfluenza 1, 2 and 3 are the most common viruses identified. Streptococcus pneumoniae is the most common bacterial cause. Broad brush calculations suggest that the NHS cost of childhood pneumonia in England is 6-8 million pound sterling per annum. This does not include family and social costs. There is potential for new vaccine strategies to decrease childhood pneumonia.